Volume 15, Number 4Original ResearchUtilization Trends and Positive Biopsy Rates for Prostate Biopsies in the United States: 2005 to 2011David G BostwickSavvas E MendrinosCarl A OlssonAnn E AndersonDeepak A KapoorThis article assesses the positive biopsy rate and core sampling pattern in patients undergoing needle biopsy of the prostate in the United States at a national reference laboratory (NRL) and anatomic pathology laboratories integrated into urology group practices, and analyzes the relationship between positive biopsy rates and the number of specimen vials per biopsy. For the years 2005 to 2011 we collected pathology data from an NRL, including number of urologists and urology practices referring samples, total specimen vials submitted for prostate biopsies, and final pathologic diagnosis for each case. The diagnoses were categorized as benign, malignant, prostatic intraepithelial neoplasia, or atypical small acinar proliferation. Over the same period, similar data were gathered from urology practices with in-house laboratories performing global pathology services (urology practice laboratories; UPLs) as identified by a survey of members of the Large Urology Group Practice Association. For each year studied, positive biopsy rate and number of specimen vials per biopsy were calculated in aggregate and separately for each site of service. From 2005 to 2011, 437,937 biopsies were submitted in . 4.23 million vials (9.4 specimen vials/biopsy); overall positive biopsy rate was 40.3%—this was identical at both the NRL and UPL (P 5 .97). Nationally, the number of specimen vials per biopsy increased sharply from a mean of 8.8 during 2005 to 2008 to a mean of 10.3 from 2009 to 2011 (difference, 1.5 specimen vials/biopsy; P 5 .03). For the most recent 3-year period (2009-2011), the difference of 0.6 specimen vials per biopsy between the NRL (10.0) and UPL (10.6) was not significant (P 5 0.08). Positive biopsy rate correlated strongly (P , .01) with number of specimen vials per biopsy. The positive prostate biopsy rate is 40.3% and is identical across sites of service. Although there was a national trend toward increased specimen vials per biopsy from 2005 to 2011, from 2009 to 2011 there was no significant difference in specimen vials per biopsy across sites of service. Increased cancer detection rate correlated significantly with increased number of specimens examined. Segregation of prostate biopsy cores into 10 to 12 unique specimen vials has been widely adopted by urologists across sites of service. [Rev Urol. 2013;15(4):137-144 doi: 10.3909/riu0600] © 2014 MedReviews®, LLCProstate cancerProstate biopsyUtilization trendsNational reference laboratory
Volume 19, Number 3News in UrologyAlternative Payment ModelsDeepak A KapoorNeal D Shore[Rev Urol. 2017;19(3):198–199 doi: 10.3909/riu193NewsinUro] © 2017 MedReviews®, LLC
Volume 21, Number 2Review ArticlesPreserving Independent Urology: LUGPA’s First DecadeReviewRobert D AsinofEarl L WalzDavid C ChaikinEvan R GoldfischerRichard G HarrisJonathan HendersonGary M KirshNeal D ShoreDeepak A Kapoor[Rev Urol. 2019;21(2/3):102–108] © 2019 MedReviews®, LLC
Volume 21, Number 2Original ResearchThe Effect of Local Antibiogram–based Augmented Antibiotic Prophylaxis on Infection-related Complications Following Prostate BiopsyOriginal ResearchJeffrey A ScottEdward M SchaefferRaoul S ConcepcionGary M KirshDeepak A KapoorNeal D ShoreGiven the number of prostate biopsies performed annually in the United States and associated infectious events as a result, we sought to determine if implementation of a standardized biopsy protocol utilizing antibiotic prophylaxis based on locally derived antibiograms would result in a decrease, relative to a contemporary control population, in the incidence of infection-related complications among community-based practices. A total of nine member groups of LUGPA participated in both a retrospective review and a prospective study of infection-related complications following prostate biopsy. Historic infectious complications, defined as chills/rigor, temperature higher than 101 °F, or documented positive blood or urine cultures, were self-reported by a retrospective review of patients undergoing prostate biopsy under the practice’s current protocol in the year prior to the study. The prospective phase of the study required each group to develop a locally derived augmented prophylaxis regimen (>2 antibiotics) based on local antibiograms. After implementation, the practices enrolled patients undergoing prostate biopsy over an 8-week period. Monitoring for infection-related complication took place over the ensuing 3 weeks post-biopsy. Seven hundred fifty-nine patients over nine practices were enrolled into the study utilizing the augmented locally determined prophylaxis protocol. There was a 53% reduction in the incidence of infection-related complication, relative to the historical rate. By developing a standardized biopsy protocol with specific emphasis on incorporating an augmented antibiotic prophylactic regimen based upon local antibiograms, we were able to demonstrate in a prospective trial across nine geographically distinct community practices a significant reduction in the incidence of infection-related complications. [Rev Urol. 2019;21(2/3):93–101] © 2019 MedReviews®, LLCAntibiotic prophylaxisProstateBiopsyDrug-resistant bacteria
Volume 22, Number 3Review ArticlesThe Impact of Systematic Safety Precautions on COVID-19 Risk Exposure and Transmission Rates in Outpatient Healthcare WorkersChiraag PatelMarcus CognettiJonathan AndersonGillian HodesAnn E AndersonKathleen LatinoDeepak A KapoorWe evaluated the impact of safety protocols, including rapid testing and contact tracing, on coronavirus disease 2019 (COVID-19) risk exposure and transmission rates amongst healthcare workers in the outpatient care setting. Over an 11-week period, a total of 254 employees representing 38% of our total workforce had potential COVID-19 exposure and underwent voluntary COVID-19 testing. Data was stratified based on severity of risk exposure and job description. During this period, the probability of a COVID exposure being high risk decreased in Administrative (293.0%; P < 0.01) and Clinical (277.0%; P < 0.01) staff; simultaneously, viral transmission rates declined in Administrative (273.4%; P = 0.03) and Clinical (269.9%; P = 0.04) staff as well. Systematic safety protocols effectively reduce exposure risk and transmission rates in outpatient healthcare workers and should be ubiquitously adopted. [Rev Urol. 2020;22(3):93-101] © 2020 MedReviews®, LLCSafetyCOVID-19 diagnostic testingContact tracing
Volume 22, Number 3EditorialFailing to Prepare Is Preparing to FailKathleen A LatinoDeepak A Kapoor[Rev Urol. 2020;22(3):91-92] © 2020 MedReviews®, LLC